Tumor histology was abstracted by cancer registrars.

The first preference was to obtain this information p38 MAPK cancer from pathology reports, followed by other sources. Stage, histological confirmation, and first-course primary-site surgery data were all available for 1998-2008. Incidence trends by stage and histological confirmation were examined for the years from 1992 through 2008. Linear regression models were used to fit trend data (Joinpoint software, version 3.3.1; IMS, Silver Spring, MD).13 Annual percent change (APC) in regression-line slopes were considered statistically significant when the trend differed from zero (P < 0.05). Incidence trends were examined by histological confirmation, stage, and reported first-course surgical and ablative therapy. Five-year cause-specific survival was estimated during the most recent decade of surveillance with follow-up of vital status (1998-2007). Cause-specific survival was selected because life tables were MLN8237 mw unavailable for most racial and ethnic groups included in this analysis, and because life tables may not reflect mortality differentials between HCC cases and the population related to screening, socioeconomic status, or health behavior.14 Cause of death was

defined as cancer, with other causes of death censored at time of death. Survival analyses were restricted to 16,020 of 18,894 reported HCC cases (85%) diagnosed in SEER-13 registries during the most recent decade of surveillance (1998-2007). Cases were excluded from survival analysis because HCC was a second or later primary cancer diagnosis (n = 2,409; 13%), case information was limited to death certificate or autopsy reports (n = 418; 2%), or because the case was alive without information on survival time (n = 47; <0.5%). For historical context, 5-year cause-specific survival of HCC cases diagnosed in SEER-9 registries was calculated for 1975-1977. Overall, race- and ethnicity-specific survival and

95% confidence intervals (CIs) were estimated by first-course therapies in descending order of survival: liver transplantation, NADPH-cytochrome-c2 reductase RFA of tumors less than 3 cm (potentially curative5), resection, local tumor destruction, all cases, and cases with no reported surgery. Stage distributions were presented by group, based on “reason no surgery performed,” “SEER historic stage A,” and “first-course primary-site surgery.” Among 1,249 cases with local tumor destruction, 75 (6%) underwent resection. Their 38% 5-year survival was similar to all cases with local tumor destruction (35%). Groups were combined for analysis. Of 21,390 HCCs diagnosed during 1998-2008, 4,727 (22%) reported liver surgery or local tumor destruction (Table 1). Interventions were reported more often among localized (39%) than regional (16%) or distant/unstaged cases (4%).